Enteric fever in returning travellers: Role of outpatient parenteral antibiotic therapy

White, B., Coia, J.E., Sykes, C., Mather, H. and Seaton, R.A. (2012) Enteric fever in returning travellers: Role of outpatient parenteral antibiotic therapy. Journal of Infection, 64(242), (doi: 10.1016/j.jinf.2011.11.019)

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Publisher's URL: http://dx.doi.org/10.1016/j.jinf.2011.11.019


In a recent review of imported enteric fever in Leicester, UK, a shift in therapy from ciprofloxacin to ceftriaxone and azithromycin was observed between 1999 and 2009,1 reflecting reduced ciprofloxacin sensitivity (MIC 0.125-1 mg/L) amongst Salmonella enterica isolates across Asia.2In the context of ceftriaxone therapy, it is recommended that 14 days therapy is used to reduce relapse risk. [3] and [4] Such prolonged parenteral antibiotic therapy has significant implications for inpatient care and associated costs.In Glasgow we have experienced increasing numbers of referrals with enteric fever to our outpatient parenteral antibiotic therapy (OPAT) service where ceftriaxone is an established treatment for patients with a range of other infectious diseases. [5] , [6] and [7] To our knowledge, experience of OPAT for enteric fever has not been described. Herein we retrospectively review 10 years experience of enteric fever in Glasgow and evaluate the role of OPAT in patient management.All patients =13 years of age in whom S.enterica serovar Typhi or Paratyphi A/B (S. Typhi/S. Paratyphi) had been isolated in blood or stool (with a clinical syndrome compatible with enteric fever) between January 2001 and December 2010 within Greater Glasgow and Clyde were identified retrospectively via the Scottish Salmonella, Shigella and Clostridium difficile Reference Laboratory (SSSCDRL) database. Clinical data were gathered by case note review and antibiotic sensitivity data from the SSSCDRL. Isolates were screened for resistance to naladixic acid and ciprofloxacin by a validated in-house method.8 From 2004, any naladixic acid or ciprofloxacin resistant isolates had the MIC confirmed by E-Test."OPAT" patients had received at least 2 consecutive doses of parenteral therapy during their primary treatment regimen without an overnight hospital stay (with or without prior hospitalisation). Others were termed "non-OPAT", including those hospitalised then discharged and subsequently receiving treatment via OPAT following relapsed infection. Broad criteria for suitability for OPAT include stable co-morbidity, non-progressing or improving infection, and ability to self care.7 Cure was defined as fever defervescence during primary therapy with discharge from hospital and no symptomatic or bacteriological relapse at follow up. Relapse described patients who responded to initial therapy but following completion subsequently became febrile again and/or bacteraemic. In assessing for complications of antibiotic therapy, liver function test (LFT) derangement was documented as treatment related if it developed/progressed after therapy started. Statistical differences between the groups were determined using 2-tailed Fisher's exact tests for categorical variables, and t test for parametric continuous variables.Fifty-four patients were identified and data were available and collected for 45 (83%) (Table 1). 19 (42%) received OPAT as part of their initial treatment episode, making up the OPAT group. 3 further patients subsequently received OPAT following relapse. The mean age was 29 years. 41 patients (91%) had recently returned from the Indian subcontinent. 37 patients (82%) were either Indian or Pakistani and had been visiting friends or relatives overseas (VFR). All patients received the majority of their treatment in the Infectious Diseases Unit either following referral by general practitioners, emergency departments or other hospitals in Greater Glasgow and Clyde Health Board.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Seaton, Dr Andrew and Coia, Dr John
Authors: White, B., Coia, J.E., Sykes, C., Mather, H., and Seaton, R.A.
College/School:College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:Journal of Infection

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